Provider Demographics
NPI:1083040448
Name:DALTON, TIFFANY (NUTRITION CONSULTANT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:NUTRITION CONSULTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6806
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6806
Mailing Address - Country:US
Mailing Address - Phone:760-285-1221
Mailing Address - Fax:
Practice Address - Street 1:78900 AVENUE 47 STE 201
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2070
Practice Address - Country:US
Practice Address - Phone:760-285-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education